As we discussed in our last article, the Aged Care Funding Instrument (ACFI) is the instrument used to determine levels of funding in residential aged care. The ACFI does not adequately recognise the additional costs associated with palliative care and only funds ‘palliative care’ at the ‘end of life’ where the definition of end of life is referenced as the ‘last week or days of life’. Providers can only claim for:

‘Palliative care program involving End of Life care where ongoing care will involve very intensive clinical nursing or complex pain management in the residential care setting.’

Home Care Packages funding does not provide any additional funding to support care recipients who are palliative, including purchasing equipment or making home medications. Providers are limited by the amount of funding set by each package level and must find funds from within the home care package funds currently being received for the client. In some instances, clients may be eligible for a higher-level package; however, there are currently long wait times for home care packages. As a result, people may:

• Die before receiving the care at the level they assessed for
• Undergo long periods of hospitalisation due to a lack of support for them to stay at home, or
• Move prematurely into a residential aged care facility even if their preference is to stay at home.

PCA has commissioned KPMG to investigate the economic value of palliative care. The 2020 report, ‘Investing to Save – The economics of increased investment in palliative care in Australia’, found that:

• In 2017, 36 per cent of deaths in Australia occurred in residential aged care
• The prevalence of highly complex needs in permanent aged care residents has increased five-fold to 53 per cent in the last decade
• Only one in 50 permanent residents receive ACFI-funded palliative care
• Palliative care services in residential aged care are under-funded and underserviced
• Funding specialist palliative care in residential aged care can reduce presentations to hospital and lead to less time in hospital.

KPMG estimates that a $1.00 investment in palliative care nurses in residential aged care can return between $1.68 and $4.14 in savings. In their report, KPMG also recommended an investment of $75 million per annum to increase the provision of palliative care within residential aged care. The investment should include both direct specialist palliative care and integrated support provided by the aged care workforce and other health professionals.

On 22 October 2020, the Royal Commission into Aged Care Quality and Safety’s Counsel Assisting presented 124 proposed recommendations to the Commissioners. PCA welcomes these recommendations to improve the aged care system, including the following recommendations relating to funding:

• Recommendation 8: A new aged care program – proposing that all home care and residential aged care programs be combined into a single program with ‘certainty of funding based on assessed need.’
• Recommendation 17: Residential Care category – suggesting the introduction of a funding category within the new aged care program for residential care with funding across four domains, including ‘palliative and end-of-life care.’
• Recommendation 9: Meeting preferences to age in place – recommending that the Australian Government clear the home care package waiting list with the immediate release of additional packages to all those on the waitlist and provide new entrants to the waitlist a package within one month of assessment.

Additionally, PCA welcomes the recommendations by the Counsel Assisting to introduce a Social Supports funding category (Recommendation 15), Assistive technology and Home Modification funding category (Recommendation 16), and increased funding for allied health in residential aged care (Recommendation 18).  These funding measures would further assist people who are palliative to receive the support, services and equipment they need and remain living in their homes if that is their preference.

Media release: Palliative care must become core business in aged care